About

Leah H Carr, MD, is an Assistant Professor of Clinical Pediatrics specializing in Neonatology and Newborn Services. She is an Attending Neonatologist at the Children's Hospital of Philadelphia and the Department of Pediatrics at the Hospital of the University of Pennsylvania. Dr. Carr is involved in clinical informatics, with expertise in neonatal-perinatal medicine, point-of-care ultrasound, and electronic health record build, data analytics, and clinical decision support. She is a core faculty member in the Department of Biomedical and Health Informatics at Children's Hospital of Philadelphia and serves as Co-Director of the Clinical Informatics Fellowship at the Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine. Her research focuses on clinical informatics, quality improvement, and patient safety in neonatal care, with numerous presentations and publications in the field.

Research topics

• Medicine
• Pediatrics
• Intensive care medicine
• Medical emergency
• Data science

Selected publications

• Leveraging 10 Days of Alert Malfunction to Improve Mature Organizational Clinical Decision Support Processes

  Applied Clinical Informatics · 2026-01-01

  articleOpen access

  Interruptive clinical decision support (CDS) alerts are intended to standardize patient care and prevent harm. However, failures can occur even in organizations with mature CDS governance and advanced analytics. These breakdowns, marked by excessive firings, workflow disruption, and clinician dissatisfaction, can provide insights into systemic weaknesses in CDS design, testing, and monitoring processes.This study aimed to examine a CDS alert malfunction as a lens for identifying system-level gaps and propose strategies to strengthen resilience in CDS operations.A retrospective analysis was conducted on an interruptive alert that was developed through a phased, multistakeholder, committee-driven process, but was removed within 10 days due to poor performance, revealing gaps that persisted despite established governance.The alert fired 1,866 times in 5 days, with a 91% dismissal rate and reports of workflow disruption. Feedback indicated provider frustration and concern for malfunction. Analysis revealed gaps in end-user engagement, testing rigor, committee reviews, and monitoring practices.CDS failures can serve as catalysts for system improvement. This case highlights actionable lessons, such as operationalizing user-centered design, clarifying testing expectations, and distributing monitoring responsibilities, to enhance CDS reliability. Even well-established governance structures must be continuously evaluated and adapted to keep pace with evolving CDS technologies, and such investments position organizations to maintain responsive, sustainable systems aligned with high-quality care.

  PublisherOA PDFDOI

• 124 Sustained high completion rate of an electronic health record integrated safety checklist over 2 years in a pediatric cardiac intensive care unit

  2025-05-01

  articleOpen access

  contributes to QI based on patient input in contrast to most QI initiatives, which is clinician driven or based on clinician reported adverse events.When systemizing this patient reported data this could potentially be a fruitful source for QI.QI based on experiences from patients will help targeting specific initiatives suggested by patients.We find that the patient suggestions is a valid and useful data source for QI and we will learn how clinicians will perceive patient suggestions for QI.The future QI initiatives will be evaluated by repeated measurement.The authors are all employed at Odense University Hospital.The authors have no competing interests.

  PublisherOA PDFDOI

• Sepsis Huddles in the Neonatal Intensive Care Unit: A Retrospective Cohort Study of Late-onset Infection Recognition and Severity Assessment

  The Journal of Pediatrics · 2024-05-28 · 2 citations

  article
  PublisherDOI

• Standardizing neonatal hypoxic ischemic encephalopathy evaluation and documentation practices

  Journal of Perinatology · 2024-02-29 · 7 citations

  articleSenior author
  PublisherDOI

• Leveraging Novel Clinical Decision Support to Improve Preferred Language Documentation in a Neonatal Intensive Care Unit

  Applied Clinical Informatics · 2024-05-01 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: Recognition of the patient and family's diverse backgrounds and language preference is critical for communicating effectively. In our hospital's electronic health record, a patient or family's identified language for communication is documented in a discrete field known as "preferred language." This field serves as an interdepartmental method to identify patients with a non-English preferred language, creating a bolded banner for non-English speakers easily identifiable by health care professionals. Despite the importance of documenting preferred language to facilitate equitable care, this field is often blank. OBJECTIVES: Using the Institute for Healthcare Improvement's Model for Improvement, our team sought to increase preferred language documentation within the neonatal intensive care unit (NICU) from a baseline of 74% in September 2021 to above 90% within 6 months. METHODS: A multidisciplinary team was assembled to address preferred language documentation. Our team incorporated guidance regarding preferred language documentation into a novel clinical decision support (CDS) tool aimed at addressing various safety and quality measures within the NICU. Our primary outcome metric was documentation of family's preferred language. Process measures included overall compliance with the CDS tool. A secondary outcome was the assessment of preferred language documentation accuracy. RESULTS: = 88) had their language preferences documented correctly. Overall compliance with the CDS tool remained at 85% throughout the project. CONCLUSION: Using a quality improvement framework coupled with a CDS initiative, our team was able to successfully and accurately improve preferred language documentation in our NICU. Future projects include strategies for more equitable care for patients with non-English preferences such as improved interpreter usage and discharge instructions in their preferred language.

  PublisherOA PDFDOI

• The Electronic Health Record as a Quality Improvement Tool

  Clinics in Perinatology · 2023-03-21 · 8 citations

  review1st authorCorresponding
  PublisherDOI

• Between‐hospital variation in clinical decision support availability for common inpatient pediatric conditions: Results of a national Pediatric Research in Inpatient Settings (PRĪS) Network survey

  Journal of Hospital Medicine · 2023-06-20 · 1 citations

  article1st authorCorresponding

  Implementing pediatric-focused clinical decision support (CDS) into hospital electronic health records can lead to improvements in patient care and accelerate quality improvement and research initiatives. However, its design, development, and implementation can be a time-consuming and costly endeavor that may not be feasible for all hospital settings. In this cross-sectional study, we surveyed Pediatric Research in Inpatient Settings (PRĪS) Network hospitals about the availability of CDS tools to gain an understanding of the functionality available across 8 common inpatient pediatric diagnoses. Among the conditions, asthma had the most extensive CDS availability, while mood disorders had the least. Overall, freestanding children's hospitals had the greatest breadth in CDS coverage across conditions and depth in CDS types within conditions. Future initiatives should examine the relationship between CDS availability and clinical outcomes as well as its relationship with hospitals' performance executing multicenter informatics projects, quality improvement collaboratives, and implementation science strategies.

  PublisherDOI

• Improving Compliance with a Rounding Checklist through Low- and High-technology Interventions: A Quality Improvement Initiative

  Pediatric Quality and Safety · 2021-07-01 · 13 citations

  articleOpen access1st authorCorresponding

  INTRODUCTION: Checklists aid in ensuring consistency and completeness in medical care delivery. However, using an improvement and safety checklist during rounds was variable in our neonatology intensive care unit (NICU), and completion was not tracked sustainably. This quality improvement (QI) initiative's primary aim was to increase compliance with checklist completion from 31% to >75% within 1 year. METHODS: A multidisciplinary QI team identified barriers to checklist completion and implemented a human factors-focused low-technology intervention (redesign of a hard-copy checklist) and later a high-technology clinical decision support tool within the electronic health record. The primary outcome measure was percent compliance with the use of the checklist. Process metrics included the duration of checklist completion. Balancing measures included staff perceptions of work burden and question relevance. RESULTS: Major barriers to checklist utilization were inability to remember, rounding interruptions, and perceived lack of question relevance to patients. Average biweekly checklist compliance improved from 31% before interventions to 80% after interventions. Average checklist completion time decreased from 46 to 11 seconds. Follow-up surveys demonstrated more respondents found questions "completely relevant" (34% pre versus 43% post) but perceived increased work burden (26% pre versus 31% post). CONCLUSIONS: Using QI methodology, human factors-based interventions, and a novel clinical decision support tool, we significantly improved efficiency and checklist compliance and created an automated, sustainable method for monitoring completion and responses. This foundational project provides an infrastructure broadly applicable to QI work in other healthcare settings.

  PublisherDOI

• Pediatric Emergency Medicine Simulation Curriculum: Vitamin K Deficiency in the Newborn

  MedEdPORTAL · 2021-01-25

  articleOpen access

  Introduction: The American Academy of Pediatrics recommends vitamin K prophylaxis at birth for all newborns to prevent vitamin K deficiency bleeding (VKDB). Despite a lack of evidence for serious harms, barriers to prophylaxis, including parental refusal, are rising, as are cases of VKDB. Methods: This simulation involved an infant presenting to the emergency department who decompensated due to a cerebral hemorrhage caused by VKDB and was treated by pediatric and emergency providers. The case was incorporated into the fellow and division monthly curricula, and participants completed postsimulation surveys. The patient required a secure airway, seizure management, vitamin K, and a fresh frozen plasma infusion upon suspicion of the diagnosis, plus a coordinated transfer to definitive care. The case included a description of the simulated case, learning objectives, instructor notes, an example of the ideal flow of the scenario, anticipated management mistakes, and educational materials. Results: The simulations were carried out with 48 total participants, including 40 fellows and eight attendings, from five different training institutions over 1 year. In surveys, respondents gave overall positive feedback. Ninety-four percent of participants gave the highest score on a Likert scale indicating that the simulation was relevant, and over 80% gave the highest score indicating that the experience helped them with medical management. Discussion: This simulation trained physicians how to recognize and treat a distressed infant with VKDB. The case was perceived to be an effective learning tool for both fellow and attending physicians.

  PublisherOA PDFDOI

• Etiologies and sequelae of extreme thrombocytosis in a large pediatric hospital

  medRxiv · 2020-06-02

  preprintOpen access

  Extreme thrombocytosis (ET, platelet count >1000 × 10 3 /ul) is an uncommon clinical finding 1. Primary ET is associated with myeloproliferative disorders, such as essential thrombocythemia 2. Secondary ET is more common and occurs in reaction to infection, inflammation, or iron deficiency. Bleeding and thrombotic complications more frequently arise in primary ET cases 1, but have been reported with secondary ET in adults 3. Etiologies and complications associated with ET in children are less well-defined, as prior pediatric studies have been relatively small or restricted to specialized patient populations 4,5. We aimed to characterize ET in a large, single-center pediatric cohort.

  PublisherOA PDFDOI

Frequent coauthors

• Lori Christ

  Children's Hospital of Philadelphia

  10 shared

• Daria F. Ferro

  Children's Hospital of Philadelphia

  6 shared

• Sarah A. Coggins

  4 shared

• Lakshmi Srinivasan

  University of Pennsylvania

  4 shared

• Kathleen Gibbs

  Nationwide Children's Hospital

  4 shared

• John Flibotte

  Children's Hospital of Philadelphia

  4 shared

• Mary Catherine Harris

  University of Pennsylvania

  4 shared

• Bolu Oluwalade

  Children's Hospital of Philadelphia

  3 shared

Labs

• Leah H Carr LabPI

Education

• Certificate in Biomedical Informatics, Institute for Biomedical Informatics

  University of Pennsylvania

  2022

• Certificate in Quality Improvement and Patient Safety, Center for Healthcare Improvement and Patient Safety [CHIPS]

  University of Pennsylvania

  2020

• MD

  University of Vermont College of Medicine

  2014

• BS, Neuroscience

  Bates College

  2010